| NPI | 1265634257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Additional Taxonomies | 1744R1102X Specialist, Research Study |
| 242T00000X Perfusionist | |
| 246QH0401X Spec/Tech, Pathology, Hemapheresis Practitioner | |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| 246XC2901X Spec/Tech, Cardiovascular, Cardiovascular Invasive Specialist | |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2007-07-08 |