| NPI | 1083908982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 80116) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 44635) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2024-02-01 |