| NPI | 1437499787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A132400) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2022-01752) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2024-08-09 |