| NPI | 1356180400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NR22673400) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 696922-01) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2025-05-05 |