| NPI | 1073141867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 44140) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 182510) |
| 208600000X Surgery (Licence: VA 0101278317) | |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2026-07-16 |