| NPI | 1356762710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 831322) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TX 831322) |
| Enumeration Date | 2014-01-02 |
| Last Update Date | 2015-01-24 |