| NPI | 1538446018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Additional Taxonomies | 172A00000X Driver |
| 146L00000X Emergency Medical Technician, Paramedic | |
| 174H00000X Health Educator | |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| 374700000X Technician | |
| 376K00000X Nurse's Aide | |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2021-08-30 |