| NPI | 1699710665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: TX K0832) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2024-10-01 |