| NPI | 1063869154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 31601) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV 7YC 966) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2022-08-11 |