| NPI | 1700202900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0020337) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA 187722) |
| 163W00000X Registered Nurse (Licence: HI 74288) | |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2023-02-03 |