| NPI | 1619046661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: WA 0024793) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 11439) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |