| NPI | 1871534776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ NJ00194900) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN550350) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2018-04-12 |