| NPI | 1245595875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 166435) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM RS20140583) |
| 208600000X Surgery (Licence: MD D0082842) | |
| 208600000X Surgery (Licence: TX R9331) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2024-05-30 |