| NPI | 1063131373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172A00000X Driver (Licence: FL S530178802140) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL 524680) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2022-08-22 |