| 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 |