| NPI | 1902787500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS K KONICKE Idmt 702-653-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2025-09-10 |