| NPI | 1780411603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4704313278) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704313278) |
| Enumeration Date | 2024-09-16 |
| Last Update Date | 2024-10-07 |