| NPI | 1528592011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY TP635) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD212060) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2023-08-25 |