| NPI | 1649628553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 132231) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MT 132231) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2023-07-19 |