| NPI | 1437445798 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: AZ 61662)  | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX R7759)  | 
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301098417)  | |
| Enumeration Date | 2011-06-24 | 
| Last Update Date | 2022-04-12 |