| NPI | 1366893059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 409487) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN409487) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2020-12-23 |