| NPI | 1386060093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: TX E1370968) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: KY I0707906) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2016-02-10 |