| NPI | 1013537398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10070471) |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery (Licence: TX BP10070471) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2023-06-15 |