| NPI | 1104464700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0020421) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN705508) |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2022-02-08 |