| NPI | 1043662224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME138668) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11018623A) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2018-12-14 |