| NPI | 1235356064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.12311) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 57744) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.12311-NA) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP009322) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2025-01-13 |