| NPI | 1821265505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other (Licence: MD N/A) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MD 0162268) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2008-05-13 |