| NPI | 1841808615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1077229) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 149884) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2025-03-03 |