| NPI | 1982200721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 653485) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NY 270835) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2020-12-08 |