| NPI | 1346424512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other |
| Additional Taxonomies | 1710I1002X Military Health Care Provider Independent Duty Corpsman |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2010-07-14 |