| 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 |