| NPI | 1215035811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.17745) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 67562) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-08-20 |