| NPI | 1588873640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101241382) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2007012462) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116014571) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-08-19 |