| NPI | 1376997692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT210390) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351029530) | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2022-04-05 |