| NPI | 1356791636 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301506652) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301109635) |
| 208600000X Surgery (Licence: NY 309316) | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2022-06-21 |