| NPI | 1376009506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: CA E156155) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2024-01-24 |