NPI | 1154803559 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 945825) |
Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 324549) |
Enumeration Date | 2018-08-31 |
Last Update Date | 2018-08-31 |