| NPI | 1164053419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704306968) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.425883) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 26430) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0020129) | |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2023-03-13 |