NPI | 1205638285 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 8554928) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 8554928) |
Enumeration Date | 2025-03-27 |
Last Update Date | 2025-09-25 |