| NPI | 1619211687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0990536-CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA 13996-NA) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2018-08-31 |