| NPI | 1821512914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ01478700) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR19229200) |
| 163W00000X Registered Nurse (Licence: NY 652953-1) | |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2023-05-23 |