| NPI | 1134575442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 1.080399-RES) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MI 4703116404) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2025-04-09 |