NPI | 1023137825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: MN 244106) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1172) |
Enumeration Date | 2007-03-29 |
Last Update Date | 2007-07-08 |