| NPI | 1669815585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 75983-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 266663) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2022-01-20 |