| NPI | 1073990545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 697839) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 413833) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |