| NPI | 1538152673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NR06349700) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 358166) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2015-04-07 |