| NPI | 1245433051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 42829) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2008-00427) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2019-07-24 |