| NPI | 1013778943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0001318621) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001318621) |
| 163W00000X Registered Nurse (Licence: DC RN1061906) | |
| Enumeration Date | 2024-01-18 |
| Last Update Date | 2024-01-18 |