| NPI | 1972509669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 107394) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7552) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2016-01-14 |