NPI | 1073877858 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: OR DO209456) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 5101025855) |
2086S0127X Surgery, Trauma Surgery (Licence: MI 5101025855) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-06-27 |
Last Update Date | 2022-03-21 |