| NPI | 1689139594 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1000635) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 347253) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2020-06-26 |