| NPI | 1619959277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: IA 3Z896) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 32896) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2018-05-23 |