| NPI | 1881610616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT RN27323) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MT 27323) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2019-02-06 |