| NPI | 1255059804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ15065300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN739949) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN739949) | |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2024-07-03 |