| NPI | 1811070808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: AK 05251001) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2025-09-11 |