| NPI | 1164471173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 864435) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX B1210229) |
| 1710I1002X Military Health Care Provider, Independent Duty Corpsman | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2020-05-09 |