| NPI | 1316302490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95377472) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX E2059605) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2024-06-13 |