| NPI | 1235642497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: OK 126799) |
| Additional Taxonomies | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| 3416L0300X Ambulance, Land Transport | |
| 146M00000X Emergency Medical Technician, Intermediate (Licence: OK 28283) | |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2017-11-09 |