| NPI | 1003344110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0094810) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 41007) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2024-08-21 |