NPI | 1104802669 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: MA B1673133) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MA B1673133) |
Enumeration Date | 2005-12-16 |
Last Update Date | 2007-07-08 |