| NPI | 1013392067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 56808) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 26768) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2023-12-11 |