| NPI | 1255609962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 86775) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN-255274) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2014-01-16 |