| NPI | 1386984615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.14539NA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2007019863) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH RN.391120-1) | |
| Enumeration Date | 2013-02-23 |
| Last Update Date | 2016-03-24 |