| NPI | 1144617440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2021-0490) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM 1144617440) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2021-08-31 |