| NPI | 1720409014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: IN 3016-2852) |
| 146N00000X Emergency Medical Technician, Basic (Licence: VA 031005926) | |
| 1710I1002X Military Health Care Provider, Independent Duty Corpsman | |
| 174H00000X Health Educator | |
| 146L00000X Emergency Medical Technician, Paramedic | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: FL 527845) | |
| Enumeration Date | 2014-01-03 |
| Last Update Date | 2023-11-30 |