| NPI | 1689248049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101288746) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL86152) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2026-06-17 |