| NPI | 1457120198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 0021176) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 210366) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2024-12-26 |