| NPI | 1255315040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.00299-NA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1055066) |
| 163W00000X Registered Nurse (Licence: OH RN.198180) | |
| 163W00000X Registered Nurse (Licence: IN 28209070A) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 44587) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2015-07-09 |