| NPI | 1972039774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 019550) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 370489) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-09-07 |