| NPI | 1679464119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: E3904089) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: E3904089) |
| Enumeration Date | 2025-07-12 |
| Last Update Date | 2025-07-12 |