| NPI | 1073121679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI A038916) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2020-07-30 |