| NPI | 1952340879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP120000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN 274453-L) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP006471B) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 40492) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-05-30 |