| NPI | 1669650693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.10047-NA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2005020681) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2013-06-01 |