| NPI | 1770073777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: E3341165) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NC60244540) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2018-05-15 |