| NPI | 1144565995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 219372) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: WA E1883158) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2012-12-05 |