| NPI | 1558660118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: WA ES01169030) |
| Additional Taxonomies | 374700000X Technician (Licence: WA HC 00156710) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2013-09-25 |