| NPI | 1710507462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-02407) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 261293) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2024-03-31 |