| NPI | 1154646479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 84354) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: VA 0101263066) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2020-09-15 |