| NPI | 1255194064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OK 211392) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OK 81110) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2024-02-05 |