| NPI | 1922303684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 70514) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.12112-NA) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2022-03-01 |