| NPI | 1134335805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS16728) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 34010315) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2022-07-12 |