| NPI | 1598393621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0067476) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0008049) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-09-08 |