| 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 |