| NPI | 1740423615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 149981) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MO P12226) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2009-04-08 |