| NPI | 1346721735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1090955) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 210945) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2023-01-21 |