| NPI | 1104983162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00215000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NO06610700) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2023-08-10 |