NPI | 1285872457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1710I1002X Military Health Care Provider Independent Duty Corpsman |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61120848) |
Enumeration Date | 2009-01-27 |
Last Update Date | 2021-08-26 |