| NPI | 1285448712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 733859) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: TX 733859) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: TX 733859) | |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-02-05 |