| NPI | 1063742682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion (Licence: TX 614002) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 614002) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2010-01-04 |