| NPI | 1093207268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.250277) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-11168) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2021-05-28 |