| NPI | 1265077887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: TX 980399) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 223923) |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2020-02-25 |