| NPI | 1831376102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374700000X Technician (Licence: MD A00049801) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MD 0151832) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2008-02-20 |