| NPI | 1225342504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: WI 6000728) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 174353-30) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: WI 6000728) | |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2011-12-22 |