| NPI | 1528557808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse Emergency (Licence: KY 1133799) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: KY 1036811-1659) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2018-05-02 |