| NPI | 1932530904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 898926) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: OK R000111696) |
| 163WC1500X Registered Nurse, Community Health (Licence: OK R000111696) | |
| 163WE0003X Registered Nurse, Emergency (Licence: OK R000111696) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OK R000111696) | |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2018-07-12 |