| NPI | 1215919873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.05448) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.253896) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2025-12-30 |