NPI | 1871173286 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0102207383) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
171000000X Military Health Care Provider | |
Enumeration Date | 2021-04-09 |
Last Update Date | 2024-05-17 |