| NPI | 1487231320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: SC 97535) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 13451) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2026-07-16 |