| NPI | 1093157380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: IA PM-99-506-11) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IA P51719) |
| Enumeration Date | 2013-07-27 |
| Last Update Date | 2013-07-27 |