| NPI | 1215408836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.019848) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 365443) |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2019-02-20 |