| NPI | 1386092773 |
|---|---|
| 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: WA MD.MD.61429679) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301109590) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2023-07-25 |