NPI | 1164097366 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2021-05-21 |
Last Update Date | 2022-04-04 |