| NPI | 1124517636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172A00000X Driver (Licence: VA T67345169) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: E1518071) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2018-05-09 |