| NPI | 1275910192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OK 39218) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 88708) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10052466) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2025-04-17 |