| NPI | 1104900968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MS 12084) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MS 12084) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2017-02-23 |