| NPI | 1225048259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 29123) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 029123) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2017-02-14 |