| NPI | 1568425213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: TN 0000018433) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 0000000116) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2007-07-08 |