| NPI | 1265136576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CA E073489) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000025473) | |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2023-03-29 |