NPI | 1154736437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NC 267056) |
Additional Taxonomies | 208600000X Surgery (Licence: GA 74379) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-06-25 |
Last Update Date | 2022-11-04 |