| NPI | 1760242861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 0021067) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.459525) |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2024-07-08 |