| NPI | 1720554389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11000817) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH LE00034709) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2020-12-08 |