| NPI | 1821363532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: AK 6820) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: FL EMT530361) |
| 164W00000X Licensed Practical Nurse (Licence: FL PN5199765) | |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2012-03-13 |