| NPI | 1740583137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: KS 15906) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: AZ 87252) |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2014-01-05 |