| NPI | 1710579990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.0020299) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.400494) |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2022-07-22 |