| NPI | 1184246126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: TX 848601) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: TX 848601) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2022-03-25 |