| NPI | 1629440243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 705674-1) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: PA 169338) |
| 163W00000X Registered Nurse (Licence: PA RN677278) | |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2015-10-22 |