| NPI | 1790623197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV 1790623197) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NV 1790623197) |
| Enumeration Date | 2026-03-24 |
| Last Update Date | 2026-03-28 |