| NPI | 1104087899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35126005) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV LL1858) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2019-01-09 |