| NPI | 1306859228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00208400) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 26NJ00208400) |
| 174400000X Specialist (Licence: NJ 26N007686500) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2025-03-19 |