| NPI | 1831666742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.019805) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 371271) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2019-03-26 |