| NPI | 1063917557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.019703) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.391139) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2018-06-06 |