| NPI | 1174962559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ND 15828) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 26241) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 191490) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2019-10-29 |