| NPI | 1558843268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 897169) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 309395) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2018-08-30 |