| NPI | 1194657262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 163W00000X Registered Nurse (Licence: WI 200266-30) | |
| Enumeration Date | 2026-06-02 |
| Last Update Date | 2026-06-03 |