| NPI | 1730542317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD 6137) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 6137) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2016-07-20 |