| NPI | 1750811709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301506855) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301111903) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-06-04 |