| NPI | 1164651170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 209886) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX B1538026) |
| Enumeration Date | 2009-07-11 |
| Last Update Date | 2009-07-11 |