| NPI | 1265695605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA TLRN074325) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 337025) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.15653) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2025-11-20 |