| NPI | 1710191101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: 2827687 (USCG Lic)) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 707579) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: M0916413 (Natl Reg)) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: 0003545 (BCCTPC)) | |
| 1710I1002X Military Health Care Provider, Independent Duty Corpsman | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2016-11-20 |