| NPI | 1720346745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2012-11-27 |