| NPI | 1386847457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00136600) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00136600) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2014-06-22 |