| NPI | 1225417363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9387237) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: FL EMT540185) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2015-05-21 |