| NPI | 1083866677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-03863) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX N7878) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX TMBPIT#BP10028995) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2020-09-17 |