| NPI | 1215550025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10071454) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 11344) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2026-06-05 |