| NPI | 1477564870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD THEODORE MILLER Independent Duty Corpsman 860-634-2876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-08-22 |