| NPI | 1609076959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q6687) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 44736) |
| 208600000X Surgery (Licence: TX BP1-0027863) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP1-0027863) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2016-02-18 |