| NPI | 1417386475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI AMD621) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: HI ATP1392) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-11-10 |
| Last Update Date | 2018-03-06 |