| NPI | 1750850442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DC MD500002922) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0100195) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2024-05-16 |