| NPI | 1396545760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 678481) |
| Additional Taxonomies | 163WA2000X Registered Nurse Administrator (Licence: TX 678481) |
| Enumeration Date | 2025-03-15 |
| Last Update Date | 2025-07-22 |