NPI | 1275929911 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: CA FD6542799) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2015-04-09 |
Last Update Date | 2021-08-11 |