| NPI | 1255796231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA18609NA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 364299) |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2016-05-02 |