| 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 |