| NPI | 1245695477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: TX 777392) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 777392) |
| 374U00000X Home Health Aide (Licence: TX 777392) | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |