| NPI | 1689719528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Additional Taxonomies | 247200000X Technician, Other |
| 146M00000X Emergency Medical Technician, Intermediate (Licence: OH NREMT-I0682827) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2013-02-15 |