| NPI | 1356131635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: WV WV083336) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WV 123967) |
| Enumeration Date | 2025-05-09 |
| Last Update Date | 2025-11-18 |