| NPI | 1407589286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL23-0102) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 32564) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2024-01-16 |