NPI | 1659790673 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: OH 35.145629) |
Additional Taxonomies | 208600000X Surgery (Licence: NC STRO-2B0WZO) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-04-08 |
Last Update Date | 2022-09-16 |