| NPI | 1992784920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: AK 02182001) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PR B1391377) |
| 171000000X Military Health Care Provider | |
| 246Z00000X Specialist/Technologist, Other | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2007-07-08 |