| NPI | 1669700415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.11549-NA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.320325-COA1) |
| Enumeration Date | 2009-12-04 |
| Last Update Date | 2017-06-05 |