NPI | 1548235278 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: NY 233183) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NY 001160-1) |
Enumeration Date | 2006-02-17 |
Last Update Date | 2007-07-08 |