| NPI | 1396967238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 121542) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: UT 356507-4405) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2024-04-24 |