| NPI | 1811650641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0021184) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KY 1162865) |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2025-08-04 |