| NPI | 1225684533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301509601) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046348) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2023-12-28 |