| NPI | 1215970975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 03649) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 162888) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2019-08-14 |