| NPI | 1154547354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4303088245) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4303088245) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2008-11-10 |