| NPI | 1649549221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.13132-NA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN605112) |
| 163W00000X Registered Nurse (Licence: OH RN33960) | |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2020-12-21 |