| NPI | 1154563336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN325270L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 26NR08427000) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2015-09-30 |