| NPI | 1598298424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: A2018904) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: SD P011001) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2017-04-07 |