NPI | 1760902639 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: NV 24300) |
Additional Taxonomies | 208600000X Surgery (Licence: RI LP03965) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT219493) | |
Enumeration Date | 2017-06-22 |
Last Update Date | 2023-09-28 |