| NPI | 1740556836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 804629) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN322688L) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2012-03-22 |