| NPI | 1578652236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 153174) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NC 153174) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0020116) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-11-12 |