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 |