| NPI | 1497028625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001616) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 351823) |
| Enumeration Date | 2012-02-19 |
| Last Update Date | 2025-01-23 |