| NPI | 1093850364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |