| NPI | 1982258430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024188708) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR14902900) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00957600) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6756) | |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2024-08-20 |