| NPI | 1679397301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1059303) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95372992) |
| Enumeration Date | 2024-11-11 |
| Last Update Date | 2024-11-11 |