| NPI | 1629610761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00971100) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00971100) |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2019-11-01 |