| NPI | 1043874431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301505522) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MDR-7719) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2022-09-15 |