| NPI | 1023717790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: ID 51573) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WA RN60616025) | |
| Enumeration Date | 2023-03-01 |
| Last Update Date | 2023-03-02 |