| NPI | 1194697607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61591002) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2026-06-29 |