NPI | 1003107244 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: MO 2018017277) |
Additional Taxonomies | 208600000X Surgery (Licence: NY 277473) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2011-04-21 |
Last Update Date | 2020-06-29 |