NPI | 1477715241 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: IN 01068565A) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125055127) |
Enumeration Date | 2008-07-01 |
Last Update Date | 2018-03-15 |