| NPI | 1144592841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MS B1978057) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2012-01-27 |