| NPI | 1902259021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 111247) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA 647111) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2021-11-10 |