| NPI | 1235429531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: NC B2009480) |
| Additional Taxonomies | 2865M2000X Military Hospital Military General Acute Care Hospital |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2018-04-16 |