| NPI | 1457093304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX l342112) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 342112) |
| 163W00000X Registered Nurse (Licence: TX 22630966) | |
| 164W00000X Licensed Practical Nurse (Licence: TX 342112) | |
| 261QC0050X Clinic/Center, Critical Access Hospital (Licence: TX A030599) | |
| 282N00000X General Acute Care Hospital (Licence: TX a35992) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX A35992) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX a030599) | |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2022-09-07 |