| NPI | 1710621479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: NY 461860) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy (Licence: NY 041122) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2022-04-27 |