NPI | 1962889907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2015-04-28 |
Last Update Date | 2024-04-24 |