| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| 261QM1102X Clinic/Center, Military Outpatient Operational (Transportable) Component |
| 261QM1103X Clinic/Center, Military Ambulatory Procedure Visits Operational (Transportable) |
| 286500000X Military Hospital |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2019-12-17 |