| NPI | 1023180205 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 46555) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 06389) | 
| Enumeration Date | 2006-11-14 | 
| Last Update Date | 2011-09-23 |