| NPI | 1265628218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WI0500X Registered Nurse, Infusion Therapy (Licence: TX 615168) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: TX 615168) |
| Enumeration Date | 2007-09-23 |
| Last Update Date | 2007-09-23 |