| NPI | 1760996037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: WA ES60075668) |
| Additional Taxonomies | 246RP1900X Technician, Pathology Phlebotomy (Licence: WA PC60348165) |
| Enumeration Date | 2017-11-25 |
| Last Update Date | 2017-11-25 |