| NPI | 1669632683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: NM RS2009-0340) |
| 208600000X Surgery (Licence: IL 036.129197) | |
| 208600000X Surgery (Licence: OK 26390) | |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2020-04-09 |