| NPI | 1164024659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: KS 27770) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: M0939140) |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2020-11-10 |