| NPI | 1326596875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 459217) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MI 4704329442) |
| 164W00000X Licensed Practical Nurse (Licence: MI 4703115986) | |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2025-09-16 |