| NPI | 1669747853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WI 1292) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 52739) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2021-08-27 |