| NPI | 1255156279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 718194) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 504321) |
| Enumeration Date | 2024-11-15 |
| Last Update Date | 2024-11-19 |