| NPI | 1194109793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO RN.1692288) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CO PN.0331509) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2023-09-14 |