| NPI | 1356444889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 065427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX D9404) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-08 |