| NPI | 1548458532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA09685NA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APRN3380) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2016-05-09 |