| NPI | 1760876817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 554549) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: NJ 26NR16538300) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2019-01-22 |