| NPI | 1821631029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 989255) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 319747) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2022-10-19 |