| NPI | 1750636544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0058936) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-4418) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2021-12-15 |