| NPI | 1588130207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP139262) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP139262) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP139262) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP139262) | |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2024-01-19 |