| NPI | 1427715242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: A001682) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH 486357) | |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2021-11-29 |