| NPI | 1902307382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 123601) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 123601) |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2018-10-08 |