| NPI | 1952018921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WV 39414) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MD 0199795) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2022-10-31 |