| NPI | 1003792896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: IA EMT4002474) |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-08-15 |