| NPI | 1376108720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00929500) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 625039-1) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NR14317000) | |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2019-07-03 |