| NPI | 1063696367 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 227900000X Respiratory Therapist, Registered (Licence: MD L04915)  | 
| Additional Taxonomies | 227900000X Respiratory Therapist, Registered (Licence: MA 5679)  | 
| Enumeration Date | 2007-12-21 | 
| Last Update Date | 2007-12-21 |