| NPI | 1023561065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TX 673922) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 673922) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2016-07-26 |