| NPI | 1043886799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34.016870) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R3621) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2026-07-31 |