| NPI | 1225395569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: CT 004299) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: CT 0002476) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2012-04-11 |