| NPI | 1639415193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: VA E081610702) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: PA 090599) |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2013-01-02 |