| NPI | 1073914511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7106) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4491) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2023-03-12 |