| NPI | 1073988531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA PTL1419) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 07-338-1206) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2022-08-23 |