| NPI | 1235293713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: AL 9142406) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT000953) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2007-07-08 |