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 | |
Enumeration Date | 2007-04-19 |
Last Update Date | 2007-07-08 |