| NPI | 1346660123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: MD 0202262) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R154738) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2014-04-21 |