NPI | 1457638710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider |
Additional Taxonomies | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
Enumeration Date | 2011-11-14 |
Last Update Date | 2011-11-14 |