| NPI | 1366884686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy |
| 146D00000X Personal Emergency Response Attendant | |
| 171000000X Military Health Care Provider | |
| 174H00000X Health Educator | |
| 247000000X Technician, Health Information | |
| Enumeration Date | 2013-07-28 |
| Last Update Date | 2025-05-14 |