NPI | 1861954240 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 208D00000X General Practice (Licence: AZ 008509) |
171000000X Military Health Care Provider (Licence: AZ 008509) | |
171000000X Military Health Care Provider | |
Enumeration Date | 2019-04-03 |
Last Update Date | 2024-04-09 |