| NPI | 1194530402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MI 4703128668) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI M5080373) |
| Enumeration Date | 2025-02-12 |
| Last Update Date | 2025-02-12 |