| NPI | 1639928385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: MA P0902420) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: NY 426356) |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2024-05-21 |