NPI | 1609294594 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NV 17178) |
Additional Taxonomies | 208600000X Surgery (Licence: NV LL2759) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-03-28 |
Last Update Date | 2020-08-25 |