| NPI | 1548976954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: VA 1314227) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: VA E202204899) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-02-28 |