| NPI | 1508609637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 98057) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: PR 98057) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2026-05-14 |