| NPI | 1124681911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351044103) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301507403) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2024-01-31 |