NPI | 1619941622 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: FL 308951) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL1620) |
Enumeration Date | 2006-02-15 |
Last Update Date | 2007-07-08 |