| NPI | 1245986140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 680524) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ01262000) |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2024-09-28 |