| NPI | 1629791686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ15411300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN682041) |
| 163W00000X Registered Nurse (Licence: NJ 26NR18039500) | |
| Enumeration Date | 2022-09-23 |
| Last Update Date | 2025-10-12 |