NPI | 1124478458 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: KY 56579) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TP 00013351) |
Enumeration Date | 2016-06-17 |
Last Update Date | 2023-01-13 |