| NPI | 1548405871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 57208) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX Q3143) |
| 2086X0206X Surgery, Surgical Oncology (Licence: TX Q3143) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 01066208A) | |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2020-07-20 |