| NPI | 1760242861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA253047) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.459525) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 0021067) | |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2025-06-24 |