| NPI | 1003276650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse Emergency (Licence: AL 1-150737) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: AL 0600909) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2016-02-24 |