| NPI | 1932288875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024175795) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555564) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2018-03-19 |