| NPI | 1255645214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0055469) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-3704) |
| 208600000X Surgery (Licence: CO TL.0003704) | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2015-09-04 |