| NPI | 1184119992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 353626) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 353626) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2024-10-28 |