| NPI | 1316189764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 080845) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.10660-NA) |
| 163W00000X Registered Nurse (Licence: OH 313328) | |
| 163W00000X Registered Nurse (Licence: KY 1103267) | |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2009-10-27 |