| NPI | 1114417599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01085666A) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2026-07-17 |