| NPI | 1316393879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 92781) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 05-43987) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2022-09-27 |