| NPI | 1538551395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00552900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 209348) |
| 163W00000X Registered Nurse (Licence: NJ 26NR17755100) | |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2020-10-27 |