| NPI | 1760151369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 160603) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 160603) |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2021-10-19 |