| NPI | 1467679654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: PA 158727) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: PA P0935862) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 029602575) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2007-07-08 |