| NPI | 1174075196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 019368) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 357443) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2022-08-23 |