| NPI | 1851780506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146L00000X Emergency Medical Technician, Paramedic (Licence: IL 060083516) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: IA PM-99-509-85) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-03-13 |