| NPI | 1568430684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: KY 278P) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: IN 9347229) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |