NPI | 1912344581 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: MA 263104) |
Additional Taxonomies | 208600000X Surgery (Licence: FL ME145670) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-05-23 |
Last Update Date | 2023-05-18 |