| NPI | 1366128324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ14872500) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 791695) |
| 163W00000X Registered Nurse (Licence: NJ 26NR21904500) | |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-07-14 |