| NPI | 1245037928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163WA2000X Registered Nurse Administrator (Licence: TX 865214) |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: AK 198483) | |
| Enumeration Date | 2025-02-28 |
| Last Update Date | 2025-02-28 |