| NPI | 1285989764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000854) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH COA.13512-NP) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2022-10-14 |