| NPI | 1275791899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2014-01404) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101255877) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2021-08-10 |