| NPI | 1396907432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A10484) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 20A10484) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2019-03-28 |