| NPI | 1396363479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NH RT-3828) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP04952) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2021-07-16 |