| NPI | 1285167965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 77041) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 167822) |
| 208600000X Surgery (Licence: CO DR0075198) | |
| 208600000X Surgery (Licence: UT 14189873-1205) | |
| 208600000X Surgery (Licence: ND 21884) | |
| 208600000X Surgery (Licence: NM MD2024-1291) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63883) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2025-10-07 |