| NPI | 1457980260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 754523) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 000421-P.A.) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2020-04-03 |