| NPI | 1710426101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: NC P116835) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000032043) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2020-02-21 |