| NPI | 1083754048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11000839) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL PMD205169) |
| 146N00000X Emergency Medical Technician, Basic (Licence: FL EMT88434) | |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: FL RN9218022) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2024-01-24 |