| NPI | 1104063809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 80917) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN274518) |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2019-01-25 |