| NPI | 1093711780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00204400) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN501475L) |
| 163W00000X Registered Nurse (Licence: NJ 26NR08622100) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2025-10-30 |