| NPI | 1073197083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL24-0798) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL83544) |
| 207R00000X Internal Medicine (Licence: SC LL83544) | |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2024-10-29 |