| NPI | 1598230005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: ND R46690) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 874538) |
| 163W00000X Registered Nurse (Licence: TN 206340) | |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2018-10-11 |