| NPI | 1821537374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ01466300) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A00773) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2023-12-02 |