| NPI | 1013624451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1031928) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 382473) |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-11-04 |