| NPI | 1215328976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 31987) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 31987) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2024-07-20 |