| NPI | 1053141697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E179258) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2025-01-29 |