| NPI | 1659816312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22382) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 019390) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2024-09-05 |