| NPI | 1487823993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: AL M0895089) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: AL 9700484) |
| 164W00000X Licensed Practical Nurse (Licence: AL 2-051885) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2015-04-01 |