| NPI | 1528434099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other (Licence: CA US NAVY IDC) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: CA US NAVY IDC) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |