| NPI | 1679954192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 75227) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11018327A) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2023-10-09 |