| NPI | 1154857969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0009741) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 57832) |
| 208600000X Surgery (Licence: AZ R76281) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-07-01 |