| NPI | 1255853230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: FL EMT563563) |
| 172V00000X Community Health Worker | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2023-10-11 |