| NPI | 1306256706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-02945) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 82483) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2021-04-14 |