| NPI | 1245373117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: NY 150757) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 195699) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2007-07-09 |