| NPI | 1003906421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.01721-NA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 42699) |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2023-11-15 |