| NPI | 1336479690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN757537) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.11288-NA) |
| 163W00000X Registered Nurse (Licence: OH Rn-318056) | |
| Enumeration Date | 2010-01-10 |
| Last Update Date | 2025-08-28 |