| NPI | 1124647409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11022914A) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351046143) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2023-07-03 |