| NPI | 1831182872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 070444) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH RN307552) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2019-05-10 |