| NPI | 1750588125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101252250) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019285) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2012-09-14 |