| NPI | 1114160439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1710I1003X Military Health Care Provider Independent Duty Medical Technicians |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: P0923280) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2009-04-16 |