| NPI | 1285054932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY TL5970) |
| Additional Taxonomies | 208600000X Surgery (Licence: HI 20382) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: HI MDR6663) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2019-10-16 |