| NPI | 1285019703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME156819) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: TX S4632) | |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2022-10-26 |