| NPI | 1710989371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3004199) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.08833-NA) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2016-02-03 |