| NPI | 1568216091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ15149100) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 729002) |
| Enumeration Date | 2024-04-12 |
| Last Update Date | 2025-06-17 |