| NPI | 1194810911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY 5410562) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 171000000X Military Health Care Provider | |
| 1710I1002X Military Health Care Provider Independent Duty Corpsman | |
| 1710I1003X Military Health Care Provider Independent Duty Medical Technicians | |
| 2472B0301X Technician, Other Biomedical Engineering | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2022-05-27 |