| NPI | 1548749633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 332765) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2026-03-24 |