| NPI | 1407065477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2013-01206) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301089909) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301089909) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2018-08-06 |