| NPI | 1275154890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX V9887) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10071715) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2026-03-24 |