NPI | 1801492848 |
---|---|
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 |
Enumeration Date | 2020-12-06 |
Last Update Date | 2021-06-19 |