| NPI | 1427638964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX V3964) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10076081) |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2024-09-14 |