NPI | 1376744599 |
---|---|
Former Name | JENNIFER E KELLER |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: CA A117557) |
Additional Taxonomies | 208600000X Surgery (Licence: NC 2007-01217) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2007-05-29 |
Last Update Date | 2022-03-30 |