| NPI | 1417782046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: NY 397822) |
| Additional Taxonomies | 172A00000X Driver (Licence: NY 109516154) |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2024-09-04 |