| NPI | 1780305235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 817876) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN634498) |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2022-09-02 |