| NPI | 1104493931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2021-06-09 |