NPI | 1376956045 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: FL OS17089) |
Additional Taxonomies | 208600000X Surgery (Licence: TX S1082) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-06-10 |
Last Update Date | 2020-11-02 |