| NPI | 1356889976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: A2008424) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: MT MED-AEMT-LIC-40939) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |