| NPI | 1336636604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00852700) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 122088) |
| Enumeration Date | 2018-04-22 |
| Last Update Date | 2023-08-01 |