NPI | 1780382465 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.084301) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2023-02-21 |
Last Update Date | 2024-06-09 |