| NPI | 1508116054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 28055) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH coa.13841-NA) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2025-09-03 |