| NPI | 1568616100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.019952) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3949) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2023-11-03 |