| NPI | 1407899792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.06862-NA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 49761) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2025-09-11 |