NPI | 1316555295 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0102208100) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2020-07-16 |
Last Update Date | 2024-05-02 |