NPI | 1285947952 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
Enumeration Date | 2010-07-22 |
Last Update Date | 2019-08-06 |