| NPI | 1437689411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: GA 80806) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: SC 91494) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2024-06-19 |