| NPI | 1396805685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: NY 056475) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 000288-1) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2007-07-08 |