| NPI | 1194613745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 774249) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: TX 774249) |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2025-06-24 |