| NPI | 1407296759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 91052) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 36085) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC 36085) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2022-04-14 |