| NPI | 1063947356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 58962) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01084018A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11019177A) | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2025-08-04 |