| NPI | 1104802875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: TN B1583538) |
| Additional Taxonomies | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians | |
| 247000000X Technician, Health Information | |
| 247200000X Technician, Other | |
| 376K00000X Nurse's Aide (Licence: MD A00065327) | |
| 376K00000X Nurse's Aide (Licence: TN 3900062) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2007-07-08 |