| NPI | 1124385265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: TX 706863) |
| Additional Taxonomies | 171W00000X Contractor |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2012-04-13 |