| NPI | 1932543659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: GA E3054072) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: GA RN225389) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2013-04-24 |