| NPI | 1265318802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: CA E178647) |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-08-11 |