| NPI | 1053828392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 929166) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MP R16510) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2018-01-09 |