| NPI | 1104302504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 802438) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-07-18 |