| NPI | 1548565732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 18551) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 367087) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 12130) | |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2022-03-16 |