| NPI | 1831731884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364S00000X Clinical Nurse Specialist (Licence: TX 1166512) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC01931) |
| 163W00000X Registered Nurse (Licence: TX 1166512) | |
| Enumeration Date | 2019-10-10 |
| Last Update Date | 2026-07-02 |