| NPI | 1982211785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 246957) |
| 163W00000X Registered Nurse (Licence: PR 099694) | |
| 163W00000X Registered Nurse (Licence: CA 95042984) | |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2023-09-22 |