| NPI | 1508541426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2023020885) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: PA 166041) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2023-06-19 |