| NPI | 1558930982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ01158600) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN693672) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 676117) | |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2024-08-15 |