| NPI | 1063171064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic |
| Enumeration Date | 2021-12-17 |
| Last Update Date | 2021-12-17 |