| NPI | 1285115899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 019734) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 363744) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2018-10-15 |