| NPI | 1538785282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116040229) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL84414) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2025-07-24 |