| NPI | 1255701025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA18565NA) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 411958) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2016-01-08 |