| NPI | 1417590597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: NH 22980) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: ME 27151) |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2019-10-22 |