NPI | 1669014452 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: MA 285093) |
Additional Taxonomies | 208600000X Surgery (Licence: MA 1054) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-10-13 |
Last Update Date | 2020-06-27 |