| NPI | 1073770814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TN 65231) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 65231) |
| 208600000X Surgery (Licence: NC 2015-01210) | |
| 2086S0129X (Licence: NC 2015-01210) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2086S0129X (Licence: NY 293910-1) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2025-07-24 |