| NPI | 1245728971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101268471) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: VA 0101268471) | |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2025-08-07 |