| NPI | 1710518907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH1000X Registered Nurse, Hospice (Licence: TX 796700) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 220375) |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2020-04-06 |