| NPI | 1861761769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: TN 37400) |
| Additional Taxonomies | 172A00000X Driver (Licence: TN 104882749) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2011-12-21 |