| NPI | 1629713532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH CRNA.0020694) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.485413) |
| 163W00000X Registered Nurse (Licence: MI RN.4704271630) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MI CRNA.239103449) | |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2023-01-11 |