| NPI | 1144595364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: VA 0002083355) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: VA B052206701) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |