| NPI | 1104845924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.09873NA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 59476) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2021-01-21 |