| NPI | 1518449693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 119484) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 635226-1) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2023-08-21 |