| NPI | 1053645085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: KY 2175794276) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: KY 00019910PT) |
| 247200000X Technician, Other | |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2011-08-06 |