| NPI | 1003083916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: NC P068629) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 134820) |
| 1710I1003X Military Health Care Provider Independent Duty Medical Technicians | |
| 246RP1900X Technician, Pathology Phlebotomy (Licence: NC 490603961045) | |
| 247200000X Technician, Other | |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2019-11-05 |