| NPI | 1508150947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A140060) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 284555) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2018-07-30 |