| NPI | 1720882061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: MI 3086) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MI E3895422) |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-05-02 |