| NPI | 1659804755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 100175) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 100175) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2025-10-29 |