| NPI | 1376837872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX BP10041441) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: AL 43082) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301115111) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2022-04-01 |