NPI | 1417142795 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: PA MD420177) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN11132) |
Enumeration Date | 2007-09-11 |
Last Update Date | 2018-04-13 |