| NPI | 1417248121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 308657) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 49396) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2018-05-03 |