NPI | 1215370531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: VA 0101269782) |
Additional Taxonomies | 208600000X Surgery (Licence: NY 300147-01) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-04-17 |
Last Update Date | 2021-03-08 |