| NPI | 1790778058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL arnp 9267932) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH NA2743) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2008-02-19 |