| NPI | 1972175057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH CRNA.0020724) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.426325) |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2023-09-05 |