| NPI | 1639533391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: IL 0000935841) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: MO P-16058) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2016-04-08 |