| NPI | 1568945376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00939300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 722944-1) |
| 163W00000X Registered Nurse (Licence: NJ 26NR16235500) | |
| Enumeration Date | 2018-09-08 |
| Last Update Date | 2023-09-21 |