| NPI | 1376871525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 835480) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 586163) |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2022-01-18 |