| NPI | 1972669729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D159170) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1345) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2020-07-17 |