| NPI | 1295901312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 070312) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 127896) |
| 208600000X Surgery (Licence: NC 2012-00630) | |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2014-03-19 |