| NPI | 1760475776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 453006) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26N009116700) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00205400) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2025-11-18 |