| NPI | 1326540873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: TX 931013) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 157150) |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2018-03-01 |