| NPI | 1225417728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0009431) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60801198) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60561734) | |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2022-07-17 |