| NPI | 1851959498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: FL 43156) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2025-06-11 |