| NPI | 1235486267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT CSP.0073460) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI L2231647) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2023-01-26 |