| NPI | 1396663472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NM 68428) |
| Enumeration Date | 2026-07-07 |
| Last Update Date | 2026-07-07 |