NPI | 1003319880 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KS 94-11640) |
Additional Taxonomies | 171000000X Military Health Care Provider |
2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AR E-12497) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-03-17 |
Last Update Date | 2024-10-07 |