| NPI | 1063931038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH CRNA019574) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH LE-00020509) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2020-10-16 |