| NPI | 1982004321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA16580NA) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH RN.341135) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28233449A) | |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2017-01-06 |