| NPI | 1326455213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.132318) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN# 20730) |
| Enumeration Date | 2014-07-13 |
| Last Update Date | 2018-03-17 |