| NPI | 1093358939 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Additional Taxonomies | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians (Licence: TX 1093358939) |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2024-02-09 |