| NPI | 1699351338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2026-03583) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: FL TRN33392) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2026-07-08 |