NPI | 1053706754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101267680) |
Additional Taxonomies | 208600000X Surgery (Licence: VA 0101267680) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-03-31 |
Last Update Date | 2022-09-10 |