| NPI | 1316142656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2020-02783) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D74766) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR LL16427) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2022-06-07 |