| NPI | 1104958891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TX 790514) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TN RN0000098744) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2011-09-14 |