| NPI | 1104708460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1062920) |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-07-25 |