| NPI | 1073772356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 51450) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX Q0174) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2021-10-28 |