| NPI | 1710303060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22165) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.15672-NA) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2017-02-21 |