| NPI | 1295519890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2025-02-05 |