| NPI | 1912342064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA I3443) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2020-08-12 |