NPI | 1750757134 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1710I1002X Military Health Care Provider Independent Duty Corpsman (Licence: CA 1750757134) |
Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: CA US NAVY IDC) |
247200000X Technician, Other (Licence: CA US NAVY IDC) | |
Enumeration Date | 2015-08-19 |
Last Update Date | 2022-01-20 |