| NPI | 1578840633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 871205) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN273276) |
| Enumeration Date | 2011-11-03 |
| Last Update Date | 2021-01-04 |