| NPI | 1699737288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: WI 304299) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 103-039) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2025-09-11 |