| NPI | 1033430343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 52615) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101257829) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2016-08-01 |