| NPI | 1568753622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: KY 55259) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2021-07-26 |