| NPI | 1598059636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WF0300X Registered Nurse, Flight (Licence: VA 0001185682) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: VA E093004104) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2011-06-07 |