| NPI | 1407171929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant |
| 146M00000X Emergency Medical Technician, Intermediate | |
| 146N00000X Emergency Medical Technician, Basic | |
| 1710I1002X Military Health Care Provider, Independent Duty Corpsman | |
| 171W00000X Contractor | |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2021-07-06 |