| NPI | 1629211693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 216573) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: TX P80281332) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2009-04-07 |