| NPI | 1700077112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A31088) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: AL A31088) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2007-08-09 |