| NPI | 1629547203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 019812) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 371665) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2456) | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2021-11-02 |