| NPI | 1770728107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| 247200000X Technician, Other | |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2023-11-21 |