NPI | 1598108672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NC 2018-01458) |
Additional Taxonomies | 208600000X Surgery (Licence: WA ML60361281) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: WA TBD) | |
Enumeration Date | 2013-04-09 |
Last Update Date | 2021-03-24 |