| NPI | 1669621421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 735578) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 735578) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2021-05-07 |