| NPI | 1063788248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-02287) |
| Additional Taxonomies | 2086S0129X (Licence: TN MD62971) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-01 |
| Last Update Date | 2025-07-24 |