| NPI | 1386957728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00036067) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 262439) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT AS2383278 - 0751) | |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2022-03-23 |