| NPI | 1700216611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201604975CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.369950) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001113) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.15521-NA) | |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2019-08-21 |