| NPI | 1700219631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP119162) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 632476) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2022-11-04 |