| NPI | 1104069210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: P8023941) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2012-01-04 |