| NPI | 1932360815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Additional Taxonomies | 286500000X Military Hospital |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2011-03-16 |