| NPI | 1750097937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11028316) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH RN.453203) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL 9620518) | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-11-08 |