| NPI | 1487368114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 95120920) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95120920) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-02-09 |