| NPI | 1629650676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10074482) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 14876) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2023-06-22 |