| NPI | 1689266280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 752724) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NY 379690) |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2021-02-05 |