| NPI | 1225718919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX V4518) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10083386) |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2024-12-10 |