| NPI | 1083296891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS026038) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151015052) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2026-06-10 |