| NPI | 1619441292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 343245) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 343245) |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2019-01-16 |