NPI | 1073045068 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NM MD2022-1121) |
Additional Taxonomies | 208600000X Surgery (Licence: CA A158665) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-03-30 |
Last Update Date | 2022-09-23 |