| NPI | 1609487578 |
|---|---|
| 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: NC M5039764) |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2020-08-28 |