| NPI | 1013107887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N5659) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 201414) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2012-11-14 |