| NPI | 1053983965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 0020427) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 397319) |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2022-01-18 |