| NPI | 1104403443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U8927) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL 543369) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: FL ME161108) | |
| 208D00000X General Practice (Licence: FL ME161108) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2024-08-05 |