| NPI | 1972987683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: GA LPN091164) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX E1946723) |
| 164W00000X Licensed Practical Nurse (Licence: TX 323645) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2015-07-13 |