| NPI | 1164774915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA 13840-NA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN 288908) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2025-03-27 |