| NPI | 1508289539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 659352) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NY 389795) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2014-01-27 |