| NPI | 1235774399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0020617) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704315948) |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2023-11-03 |