| NPI | 1417439373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 970529) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 323654) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2019-07-05 |