| NPI | 1275944555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301105212) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105212) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2021-12-20 |