| NPI | 1639888944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM 71128) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 954442) |
| Enumeration Date | 2022-11-16 |
| Last Update Date | 2023-08-24 |