| NPI | 1073275863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X Phlebology (Licence: CA CPT-02132043) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E140235) |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2021-10-08 |