| NPI | 1467617993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 57044) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101251720) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2020-09-10 |