| NPI | 1194931642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00321700) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NO11850700) |
| 363AS0400X Physician Assistant Surgical (Licence: NJ 25MP00103200) | |
| 363L00000X Nurse Practitioner (Licence: NJ 26NJ00321700) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2016-08-25 |