| NPI | 1457890824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: GA 44323) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2017-02-18 |
| Last Update Date | 2022-01-27 |