| NPI | 1720090376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: VA 0101243579) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101243579) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2021-01-21 |