| NPI | 1679378616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: TX 1224179) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX 768753) |
| 163W00000X Registered Nurse (Licence: TX 1224179) | |
| Enumeration Date | 2025-02-14 |
| Last Update Date | 2026-02-03 |