NPI | 1790121374 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OR MD216477) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301102983) |
Enumeration Date | 2013-05-22 |
Last Update Date | 2023-07-27 |