| NPI | 1174288765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0021178) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 452998) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2025-01-06 |