| NPI | 1720583073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704241784) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704241784) |
| 163W00000X Registered Nurse (Licence: OH RN.412743) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.019646) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2019-07-12 |