NPI | 1851887384 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A153516) |
Additional Taxonomies | 208600000X Surgery (Licence: CA A153516) |
261QU0200X Clinic/Center, Urgent Care (Licence: CA A153516) | |
Enumeration Date | 2018-07-09 |
Last Update Date | 2021-12-23 |