| NPI | 1023882677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA E187094) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E187094) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2025-06-11 |