| NPI | 1336911213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 171000000X Military Health Care Provider | |
| 171400000X | |
| 175T00000X Peer Specialist (Licence: OH APS.004984) | |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2024-04-30 |