| NPI | 1265619431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AK 34522) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: B1447126) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2013-02-20 |