| NPI | 1063664548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: NY 245689) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA09623400) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2019-07-10 |