| NPI | 1538326152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 46781) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11012974A) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2016-05-02 |