| NPI | 1497345904 |
|---|---|
| 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: CA 152871) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: CA 152871) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2025-02-11 |