| NPI | 1427284603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: FL PN1150051) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX B1448799) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2009-06-02 |