| NPI | 1265055073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A201178) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI MDR-7934) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-06-27 |