| NPI | 1740737162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704359441) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MI 3203057152) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2020-03-03 |