| NPI | 1962088054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH APRN.CRNA.0020551) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.397971) |
| 163W00000X Registered Nurse (Licence: MI 4704347278) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-20 |
| Last Update Date | 2022-06-28 |