| NPI | 1295079234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: MI 1620749) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NY 413026) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2020-03-02 |