| NPI | 1720420680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 95954) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.136105) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-20 |
| Last Update Date | 2023-10-18 |