| NPI | 1942892922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse Administrator (Licence: TX 728474) |
| Additional Taxonomies | 163WP2201X Registered Nurse Ambulatory Care (Licence: TX 728474) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2021-02-10 |