| NPI | 1194107615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 58628) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY R3708) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2024-07-26 |