| NPI | 1871229229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247100000X Radiologic Technologist (Licence: 1045583) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: E3148196) |
| 1710I1002X Military Health Care Provider, Independent Duty Corpsman | |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2022-07-28 |