| NPI | 1205369147 |
|---|---|
| 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: MO 2018017658) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2023-05-12 |