| NPI | 1891230793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4029528) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 019385) |
| Enumeration Date | 2016-12-31 |
| Last Update Date | 2024-11-26 |