| NPI | 1629637152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: MD 1851966) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: VA B103017909) |
| Enumeration Date | 2019-06-09 |
| Last Update Date | 2019-06-09 |