| NPI | 1063991990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1087860) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 334234) |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2022-08-22 |