| NPI | 1679730113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2008-01053) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 117201) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-09-02 |