| NPI | 1417382409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: TX M5024337) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 210761) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2018-08-23 |