| NPI | 1629242037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101271193) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL L.4246R) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2022-04-25 |