| NPI | 1558195040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2024-08-28 |