| NPI | 1043605249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 92572) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2022-08-15 |