| NPI | 1427805928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351052691) |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2025-04-23 |