| NPI | 1609079342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ NJ00293500) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN529392L) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2010-06-29 |