| NPI | 1578331468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146M00000X Emergency Medical Technician, Intermediate (Licence: TX 746020) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: CAS24407733) |
| Enumeration Date | 2023-12-19 |
| Last Update Date | 2024-06-25 |