| NPI | 1629745260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 0020616) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 313183) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2022-09-08 |