NPI | 1629669643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: MD 9976) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 9976) |
Enumeration Date | 2021-02-02 |
Last Update Date | 2021-02-02 |