NPI | 1548697485 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians (Licence: 1548697485) |
Additional Taxonomies | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
Enumeration Date | 2013-10-10 |
Last Update Date | 2023-03-23 |