| NPI | 1043917859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OH RN.431267) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 0020808) |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2024-01-05 |