John Wallace, IDC Valid NPI

Individual provider · Independent Duty Corpsman · Norfolk, VA

NPI

1316926066

Type

Individual (Type 1)

Primary specialty

Independent Duty Corpsman (Military Health Care Provider)

Specialty group

Other Service Providers

Taxonomy code

1710I1002X

Sex

Male

Sole proprietor

No

Enumerated

2006-01-11

Last updated

2007-07-08