| NPI | 1518095264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: AK 397) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 290) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2007-07-08 |