| NPI | 1215322144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME136152) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207P00000X Emergency Medicine (Licence: KY 51294) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2026-04-27 |