| NPI | 1235598897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2023007759) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 7260) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK FW0545648) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 7260) | |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2023-03-09 |