| NPI | 1639238538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 701508) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 0100006148) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2008-04-20 |