| NPI | 1588710669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 75814) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH RN278929COA1) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 276726) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2017-11-03 |