| NPI | 1316735814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: NY 518910) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: NY 30297918) |
| Enumeration Date | 2025-04-25 |
| Last Update Date | 2025-04-25 |