| NPI | 1235850249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 692837) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI RN-71210) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2022-09-07 |