| NPI | 1124897764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 867588) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9695878) |
| 171000000X Military Health Care Provider (Licence: NY 867588) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: PR 3407) | |
| 163WS0200X Registered Nurse, School (Licence: PR 84366) | |
| 163W00000X Registered Nurse (Licence: PR 84366) | |
| Enumeration Date | 2023-12-22 |
| Last Update Date | 2025-10-15 |