| NPI | 1548605900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R7583) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10047816) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2023-03-16 |