| NPI | 1568483261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 189508) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 25495) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-11-25 |