| NPI | 1710466735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP2201X Registered Nurse, Ambulatory Care (Licence: TX 981134) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 300437) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2024-07-12 |