| NPI | 1588082176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 82854) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2025-01726) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2026-05-11 |