| NPI | 1093276115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DR.0065223) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO TL0007559) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2021-02-27 |