| NPI | 1477269991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2012013122) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MO P16132) |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2023-02-02 |