| NPI | 1508624198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC0200X Registered Nurse Critical Care Medicine (Licence: VA 0001252399) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: VA B051581016) |
| Enumeration Date | 2024-03-08 |
| Last Update Date | 2024-03-08 |