| NPI | 1902318314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider Independent Duty Medical Technicians |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL 535230) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: M5025927) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: LA LA15-013283) | |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2022-12-01 |