| NPI | 1164081782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351045522) |
| 208600000X Surgery (Licence: MI 390200000X) | |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2024-04-06 |