| NPI | 1407088511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 129666) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 242001) |
| Enumeration Date | 2009-08-23 |
| Last Update Date | 2023-07-25 |