| NPI | 1023596772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 725331) |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: TX 725331) |
| Enumeration Date | 2018-08-04 |
| Last Update Date | 2018-08-04 |