| NPI | 1497277206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: TX 233533) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX E3260943) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2022-07-21 |