NPI | 1336101435 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: MA 842787) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MA 1501) |
163W00000X Registered Nurse (Licence: MA 269340) | |
Enumeration Date | 2006-04-04 |
Last Update Date | 2007-07-08 |