| NPI | 1457794844 |
|---|---|
| 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: MD D86117) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2024-06-25 |