NPI | 1740675057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: NY 303070) |
Additional Taxonomies | 208600000X Surgery (Licence: OH 35.134380) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-04-02 |
Last Update Date | 2023-06-30 |