| NPI | 1396959227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: AR R72936) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: AR 8299) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2025-09-11 |