| NPI | 1720727175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN756924) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: PA 226652) |
| 163WE0003X Registered Nurse, Emergency (Licence: NJ 26NR24419700) | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2023-09-25 |