| NPI | 1720839822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA pending) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 3016649) |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2024-04-25 |