| NPI | 1710197116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD156066) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR LL16091) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2017-02-03 |