| NPI | 1144639493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN22497) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: GA 41269) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2014-08-11 |