| NPI | 1326485897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2020011590) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS16028) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2020-10-20 |