| NPI | 1013235951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-785A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 11837-NA) |
| Enumeration Date | 2010-05-15 |
| Last Update Date | 2016-11-16 |