NPI | 1831693613 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: NY 333675) |
Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NY 333675) |
208600000X Surgery (Licence: MA 285867) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-03-19 |
Last Update Date | 2025-08-14 |