| NPI | 1679132575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.019950) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: OH RN364257) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2020-12-09 |