| NPI | 1740833813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Additional Taxonomies | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians (Licence: 1740833813) |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2023-07-03 |