| NPI | 1316488737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 161652) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 158851) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2024-04-08 |