| NPI | 1598129207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 000000000000) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2026-04083) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2026-09-02 |