| NPI | 1396069837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA FP3215387) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN 15454) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL P425014832120) | |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2021-12-03 |