NPI | 1144602178 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1710I1002X Military Health Care Provider Independent Duty Corpsman |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2015-06-25 |
Last Update Date | 2015-06-25 |