| NPI | 1477641405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ NO07823500) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN272385L) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2016-04-12 |