| NPI | 1790433142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: MA E3481476) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MA E0917491) |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2022-03-15 |