| NPI | 1164872420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 3201011429) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 3205002392) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2016-06-17 |