| NPI | 1053730176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IN 02005665A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101021123) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2022-02-22 |