| NPI | 1306177514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA 11312-NA) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: OH RN. 308471-COA1) |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2010-01-28 |