| NPI | 1609651801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024194185) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 466075) |
| 163W00000X Registered Nurse (Licence: OH 466075) | |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2026-01-16 |