NPI | 1609880590 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: LA B0467966) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: LA J00010) |
Enumeration Date | 2006-07-28 |
Last Update Date | 2007-07-08 |