| NPI | 1710727003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 16271) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC MIXS-3YY8IP) |
| Enumeration Date | 2024-05-25 |
| Last Update Date | 2025-04-30 |