| NPI | 1053331546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP130882) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN181018) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN181018) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2022-01-12 |