| NPI | 1174576482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.00404-NA) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 199055) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2015-04-30 |