| NPI | 1760737043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA RN574667) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00386300) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2018-06-13 |