| NPI | 1922204163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 156FX1101X Technician/Technologist, Ophthalmic Assistant |
| 156FX1202X Technician/Technologist, Optometric Technician | |
| 235500000X Specialist/Technologist | |
| 242T00000X Perfusionist | |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| 2355A2700X Specialist/Technologist, Audiology Assistant | |
| 247000000X Technician, Health Information | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2022-02-25 |