| NPI | 1396195582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95025605) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2021-02-02 |