| NPI | 1679164388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ01175800) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR20624600) |
| 163W00000X Registered Nurse (Licence: DE L1-0051400) | |
| 163W00000X Registered Nurse (Licence: PA RN650945) | |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2022-05-17 |