| NPI | 1417479742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 45215) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301113123) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2023-03-29 |