| NPI | 1255702015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 887208) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 40034) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2015-10-19 |