| NPI | 1659890119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00766100) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NR11296200) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN551368) | |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2020-04-03 |