| NPI | 1396988184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: P0900513) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2009-04-09 |