| NPI | 1417307745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 97828) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL 0006339) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2016-12-07 |