| NPI | 1184281602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID 8181303) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 1184281602) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2026-09-01 |