| NPI | 1326255399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101247868) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116017616) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2011-08-02 |