| NPI | 1780060988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 603096) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 153131) |
| 163W00000X Registered Nurse (Licence: PA RN597760) | |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2015-08-11 |