| NPI | 1811066939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00224800) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NO11685900) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN353988L) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2015-05-18 |