| NPI | 1609602481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP2201X Registered Nurse, Ambulatory Care (Licence: TX 796492) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 796492) |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2024-09-10 |