| NPI | 1174285092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: TX E1840660) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2021-10-07 |