| NPI | 1710250451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: AL P8040346) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: AL 9900070) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2015-03-04 |