| NPI | 1013304963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2024-01973) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: TN 56273) | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2024-07-16 |