| NPI | 1811729460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic |
| 174H00000X Health Educator | |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2024-08-14 |