| NPI | 1649899337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 18723) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: RI MD20592) | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2026-09-01 |