| NPI | 1164714457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: 4341-4744-6009) |
| 247200000X Technician, Other | |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2024-09-12 |