| NPI | 1659187979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: NJ 566558) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: 1438-3160-4758) |
| Enumeration Date | 2024-12-11 |
| Last Update Date | 2024-12-11 |