| NPI | 1033789060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R77274) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R77274) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2022-12-07 |