| NPI | 1013132406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: MS 21415) |
| Additional Taxonomies | 2086X0206X Surgery Surgical Oncology (Licence: TX P6488) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2015-09-29 |