NPI | 1174910251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: PR 21944) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 32676) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-04-16 |
Last Update Date | 2020-10-06 |