| NPI | 1154552164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.16393) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 114667) |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2023-10-30 |