| NPI | 1801871744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.00650-NA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 193553) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2009-06-04 |